<html>
<head>
<title>CBVsite</title>

<style type="text/css"> 
table.date {background-color: grey}
td.date {font-size: 12; color: skyblue}
table.menu {background-color: skyblue; width: 100%; height: 400}
td.menu {background-color: white; text-align: center; font-size: 12; width: 15%; height:20}
a:link {color: blue}
a:visited {color: black}
a:hover {color: #FF00FF; font-style: italic}
a:active {color: #00FF00}

</style>

<body>
<div id="date-search">
   <table class="date" width="780" border="0" align="center" cellpadding="0" cellspacing="0">
      <tr>
	<td class="date" width="15%" align="left">	
             <script language="javascript">
               var x=new Date();
               var myDate=x.getDate();
               var myMonth=x.getMonth();
               var myYear=x.getYear();
               document.write("<b>&nbsp;Date:" + myDate + "/" + "0"+(myMonth+1) + "/" +"0"+ (myYear-100)+"</b>");
            </script>
       </td>
       <td width="85%" align="right">
           <B>Search :</B><input type = text><input type=button value="go">
       </td>
     </tr>
   </table>
</div>

<hr width="780" color=skyblue ></hr>

<table width="780" border="0" cellpadding="0" cellspacing="0" vspace="0" hspace="0" align="center" height="400">
     <tr valign="top"><td width="100">
     <div class="sidebar"><table class="menu">
     <tr valign="top">
        <td class="menu">
            <A href="/databank/login" Title="enter your login ID"><B>Login</B> </A>
         </td></tr>

<tr><td class="menu">
<A href="contact" Title="retrieve contact details"><B>Contact</B></A>
</td></tr>
<tr><td class="menu">
<A href="sales" Title="retrieve sales details "><B>Sales</B></A>
</td></tr>
<tr><td class="menu">
<A href="computer" Title="retrieve computer details"><B>Computer</B></A>
</td></tr>
<tr><td class="menu">
<A href="recipients" Title="retrieve recipients details "><B>Recipients</B></A>
</td></tr>
<tr><td class="menu">
<A href="reports" Title="retrieve reports"><B>Reports</B></A>
</td></tr>
<tr><td class="menu">
<A href="/databank/" Title="home page"><B>Home</B></A>
</td></tr><tr><td></td></tr>	        
     </table></div>
  </td><td colspan="5"></td><td width="85%">

<div class="newform">
<form id="newform" method="post">
<table border="0" width="100%" height="400" bgcolor="lightblue" align=center>
<tr valign="top"><th colspan="2" bgcolor="grey" align="left"><font size="3" color="white">&nbsp;&nbsp;<u>New Contact Form<u></font></th></tr>
<td valign="top"><br>
<b>&nbsp;&nbsp;<u>Step I</u></b><br><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>First Name </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>Address </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;State  </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text" value="--choose any state--"><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>Concession<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Card No.</B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<input type="text"><br><br>
&nbsp;&nbsp;&nbsp;&nbsp;Home Phone </B>&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;&nbsp;&nbsp;E-mail </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
</td>

<td valign="top"><br>&nbsp;&nbsp; Mandatory fields <span><font color="red">* </font></span><br><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>Last Name </B>&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>Suburb </B>&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;<span><font color="red">* </font></span>Post Code </B>&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br><br>

&nbsp;&nbsp;&nbsp;<span><font color="red">* </font></span>Ref. Org. </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;&nbsp;<span><font color="red">* </font></span>Mobile </B>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="text"><br><br>
</td>
</tr>
<tr><td><b>&nbsp;&nbsp;<u>Step II</u></b><br><br>
&nbsp;&nbsp;Computers used for:&nbsp;&nbsp;<input type="text"><br><br>
&nbsp;&nbsp;Operating system:&nbsp;&nbsp;Linux: <input type="checkbox">&nbsp;&nbsp; Windows <input type="checkbox"> <br><br></td>
<td><br><br><br>
Computer skills:&nbsp;&nbsp; <input type="text"><br><br>
Using Internet:&nbsp;&nbsp;Yes <input type="radio">&nbsp;&nbsp; No <input type="radio"><br>
If yes:
  &nbsp;&nbsp;Dial-up <input type="checkbox">&nbsp;&nbsp; Broadband<input type="checkbox">
<br><br></td></tr>
<tr><td align="left"><br>
&nbsp;&nbsp;Form Received  by: &nbsp;&nbsp;<input type="text">
<br><br>
<input type="submit" value="submit"><input type="submit" value="reset">
</td></tr>
</table>
</form>
</div></td>
</table>
</body>
</html>

 


